“I remember a few seasons ago on an episode of The Ultimate Fighter one of the guys got kicked off because he had herpes on his head. I didn’t even know that could happen! How the hell does someone get herpes on their head? Can you catch it off a gym mat or something?” &mdash James D., Little Rock, Arkansas

I believe you’re talking about Paul Bradley, who was given the boot by UFC owner Dana White after he was diagnosed with “Herpes Gladiatorum” (HG), a viral infection of the skin that is relatively common among wrestlers and participants of other grappling contact sports. Although I know nothing about Mr Bradley’s case other than what I saw on T.V., I can give you some information about this condition in general.

Herpes Gladiatorum is caused by the Herpes Simplex I virus (HSV-I), the same virus that causes cold sores on your lip. People with HG have recurrent bouts of blistery rash, usually in the same area of the skin. Each blister contains viral particles that can be transmitted to others by direct skin-to-skin contact. After an outbreak clears up, the virus hides in the nervous system where it is safe from antibodies (that can’t cross their protective barrier). During periods of stress, or factors we don’t understand, the virus comes out of hiding and causes recurrent skin lesions.

Herpes viruses have been detected on inanimate objects for up to seven days so it’s theoretically possible to pick up an infection from a piece of equipment if it hasn’t been disinfected properly. However, rigorous mat disinfection has not prevented several outbreaks of HG in high school wrestling, so skin-to-skin remains the accepted route of transmission. There is evidence that treating people with HG with antiviral medications like Valtrex helps to prevent HG spread. Due to the high prevalence of the virus in high school wrestlers, some experts have recommended treatment during wrestling season for all who test positive for the virus.

If you’ve been exposed to herpes simplex virus before, you may have some defense against HG. By the time people reach adulthood, about 50% have been exposed to HSV-1 and have protective antibodies; this number increases with age. In contrast, most cases of HSV-2 (the virus that most often causes genital herpes) are acquired after adolescence and “only” 22-25% of the population has antibodies to that infection. This is still a huge number; herpes is a very, very common recurrent viral infection.

If you suffer from HG, you should take medication to suppress it at times when you’re at risk for transmitting the virus. If there’s no chance your lesions will come into contact with another person’s skin or equipment, it’s very unlikely that you’ll transmit the virus to someone else. If you don’t suffer from HG and are worried about getting it, you can relax if you’re doing casual workouts in a gymnasium as your risk seems to be so low as to be unreportable in the medical literature. If, however, you’re a competitive grappler, make sure you lobby your local conference to enforce isolation and treatment of infected combatants. The outbreak during the 1999 Minnesota State High School League (MSHSL) wrestling season involved 61 wrestlers and three coaches on 19 teams over 42 days and it was estimated that infected wrestlers had a 33% probability of transmitting the virus to people they sparred with.

If you’re the owner of a Mixed Martial Arts franchise and have a client who has HG, studies have shown that isolation during the outbreak, then suppressive treatment with Valtrex, Famvir or Zovirax will significantly decrease transmission of the virus to your other fighters. This information may help you prevent firing someone with potential in mid-season (unless the exigencies of reality television prevent you from allowing someone 8-10 days off.)

**Remember, don’t do anything you read here without first consulting with your own health care provider.**

Dr. Steve is the resident medical expert for the Opie and Anthony and Ron and Fez shows, and the host of his own Sirius XM Radio program, Weird Medicine.